Toe walking can be a commonly observed movement pattern that many young children display during their development, however many children will give up idiopathic toe walking (ITW) without specific intervention. Research within the scientific community suggests that ITW is sometimes a causal symptom related to other conditions. Toe walking may be a symptom of a physical condition such as spinal dysraphism or injury, myopathy, and neuropathy.1 Children may also toe walk because of low muscle tone. When children’s adnominal muscles are weak, they depend on toe walking to feel secure while moving. If the underlying reason for toe walking is not caused by physical differences, it can be an indication of motor, visual motor, and gross motor delays that are associated with neurological conditions2 such as cerebral palsy, autism and sensory processing issues.
Children who toe walk may have an increased or decreased sensitivity to sensory information. This means that they process information differently through the vestibular, tactile and proprioception systems, which may make it difficult to coordinate body movements. The body’s vestibular system controls our sense of movement and balance. Children with sensory issues related to the vestibular system have a different awareness of their body position and feel stabilized while toe walking. Our sense of touch, pain and temperature is part of the tactile system. Some studies conclude that children with differences in vestibular processing can also have tactile senses that exacerbate their toe walking. They may not like the feeling of the floor touching their feet, and toe walking minimizes this contact. Children seeking proprioceptive input toe walk, because the gait prolongs stimulation of joint receptors and causes their muscles to tighten. The movement provides a calming input sensation for the child.3
Parents should consult their pediatrician if they notice that their child continues toe walking beyond the age of two.4 They should also be aware of other behaviors that may require additional evaluation such as language delays, poor eye contact, repetitive behaviors, tightness in muscles and delays in meeting milestones.
There is a wide range of treatment options available for ITW and methods of treatment vary based on the underlying cause of toe walking. Stretching and physical therapy is usually suggested as the first treatment to be implemented because it is minimally invasive. Casting, ankle foot orthosis (AFOs), and botox injections are other options that can be effective. Specialists may suggest surgery for children who do not respond to more conservative treatments.2 Children with autism or other developmental conditions can be referred for consultation and specialized treatment given by a pediatric physical or occupational therapist.
Doctors and parents can receive more information about early childhood development and milestones at www.pathways.org or through email at firstname.lastname@example.org. Founded in 1985, Pathways.org empowers parents and health professionals with free educational resources on children’s motor, sensory, and communication development.
 Sala D, Shulman L, Kennedy R, Grant A, Chu M. Idiopathic toe-walking: a review. Developmental Medicine & Child Neurology. Feburary 2007; 41(12): 846-848.
 Deizell E. Idiopathic toe walking: Insights on intervention. Lower Extremity Review. LER Home page. www.lermagazine.com. Accessed 10 Nov 2014.
 Williams et al. Idiopathic toe walking and sensory processing dysfunction. Journal of Foot and Ankle Research. 2010: (3)16.
 Persicke A, Jackson M, Adams A. Brief Report: An Evaluation of TAGteach Components to Decrease Toe-Walking in a 4-Year-Old Child with Autism. Journal of Autism and Developmental Disorders. April 2014; 44(4):965-968.